Contents
- Aetiology
- Predisposing factors
- Symptoms of photokeratitis
- Signs of photokeratitis
- Differential diagnosis
- Management by optometrist
- Management category
- Possible management in secondary care or local primary/community pathways where available
- Evidence base
- Summary
Aetiology
Photokeratitis is a condition that occurs following unprotected exposure to ultraviolet radiation. It is characterised by damage to corneal epithelial cells and delayed onset of symptoms.
It results from exposure to UVB (290 to 320nm) or UVC (100 to 290nm). Sources include: welding arcs, sun (including reflection from snow or water), tanning lamps, therapeutic high intensity UV (for skin conditions or seasonal affective disorder), germicidal UV lamps, other sources of UVB or UVC.
Absorption of ultraviolet radiation by corneal epithelium causing damage to superficial cells and exposure of corneal nerves.
Predisposing factors
Lack of suitable eye protection
Greater UV exposure at high altitudes
Occupational exposure
Symptoms of photokeratitis
Delay of 6-12 hours between exposure and onset of symptoms is usual; however, latency varies inversely with exposure dose and can be as short as 1 hour
Mild cases:
- irritation and foreign body sensation
Severe cases:
- pain
- redness
- photophobia
- blepharospasm
- lacrimation
- blurring of vision
Signs of photokeratitis
Typically bilateral (if unilateral, suspect corneal or subtarsal foreign body)
Lid oedema and hyperaemia
Conjunctival hyperaemia
Epiphora
Punctate staining of corneal epithelium with fluorescein (may be coalescent)
Transitory reduction in visual acuity
Associated facial or eyelid erythema (‘skin burns’)
Differential diagnosis
Careful history usually reveals diagnosis
Acute viral keratoconjunctivitis
Contact or toxic keratitis
Contact lens overwear
Dry eye
Foreign body
Management by optometrist
Practitioners should work within their scope of practice, and where necessary seek further advice or refer the patient elsewhere
GRADE*Level of evidence and strength of recommendation always relates to the statement(s)immediately above
Non pharmacological
Advise against continuing exposure
Reassure patient that
- damage is transitory
- symptoms typically resolve within 24 to 48 hours (mild photophobia and blurring may persist for a week or longer)
Cold compresses, sunglasses for symptomatic relief
Advise rest with eyes closed
Close monitoring (corneal epithelium should have largely healed by the following day)
Advise patient to return/seek further help if symptoms persist
Advise patient on future eye protection
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Pharmacological
Local anaesthetic (benoxinate or proxymetacaine) should only be used if required to aid examination, and not for pain relief
Drops: tear supplements (preferably unpreserved) for symptomatic relief
Ointment: unmedicated (to ease discomfort through lubrication)
Oral analgesic for pain relief (e.g. ibuprofen, paracetamol)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Antibiotic (e.g. gutt. chloramphenicol) as prophylaxis against infection, if risk high (e.g. large epithelial defect)
Cycloplegic (short acting: e.g. gutt. cyclopentolate 1%) to relieve pain of ciliary spasm
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Management category
B3: management to resolution by Optometrist
Possible management in secondary care or local primary/community pathways where available
Additional guidance may be available
Not normally required
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and Evaluation(www.gradeworkinggroup.org)
Sources of evidence
Bergmanson JP.Corneal damage in photokeratitis--why is it so painful? Optom Vis Sci. 1990;67(6):407-13
Cullen AP. Photokeratitis and other phototoxic effects on the cornea and conjunctiva. Int J Toxicol. 2002;21:455-64
DynaMed Plus. Photokeratitis (updated 2018).
Protective eyewear: A reference guide for ABDO members. 2014.
Remé CE, Rol P, Grothmann K, Kaase H, Terman M.Bright light therapy in focus: lamp emission spectra and ocular safety. Technol Health Care. 1996;4(4):403-13
Wang Y, Lou J, Ji Y, Wang Z. Increased photokeratitis during the coronavirus disease 2019 pandemic: Clinical and epidemiological features and preventive measures. Medicine (Baltimore). 2021;18;100(24):e26343
Summary
What is Photokeratitis?
This condition is also known as Arc Eye and Snow Blindness. It is caused when the eyes are exposed to too much ultraviolet (UV) light. After a delay of 6 to 12 hours following exposure to arc welding, sun lamps or other sources of UV light, the eyes become red, painful, watery and unduly sensitive to light. The vision may become blurred and the eyelids may be red and swollen. These symptoms are caused by temporary damage to the cells on the surface of the eye.
How is Photokeratit* managed?
Fortunately the condition gets better by itself and there is usually no permanent damage. Eye drops can be prescribed to make the eyes more comfortable while they recover. Pain relief tablets may be needed also.
Photokeratitis (Ultraviolet [UV] burn, Arc eye, Snow Blindness)
Version 14
Date of search 02.10.23
Date of revision 27.11.23
Date of publication 23.01.24
Date for review 01.10.25
© College of Optometrists
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